Utilization Management Nurse

CenterWell • Prior Lake, MN

47d • Remote

About The Position

Become a part of our caring community and help us put health first Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX Use your skills to make an impact

Requirements

• Active RN license
• Possession of or ability to obtain Compact Nursing License
• A minimum of three years clinical RN experience; Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience
• Demonstrates Emotional Maturity
• Ability to work independently and within a team setting
• Valid driver’s license and/or dependable transportation necessary
• Travel for offsite Orientation 2 to 8 weeks
• Travel to offsite meetings up to 6 times a year as requested
• Willing to work in multiple time zones
• Strong written and verbal communication skills
• Attention to detail, strong computer skills including Microsoft office products
• Ability to work in fast paced environment
• Ability to form positive working relationships with all internal and external customers
• Available for On Call weekend/holiday rotation if needed

Nice To Haves

• Education: BSN or bachelor’s degree in a related field
• Experience with Florida Medicaid
• Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
• Compact License preferred
• Previous experience in utilization management within Insurance industry
• Previous Medicare Advantage/Medicare/Medicaid Experience a plus
• Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
• Bilingual

Benefits

• medical, dental and vision benefits
• 401k with company matching
• tuition reimbursement
• 3 weeks paid vacation time
• paid holidays
• work-life balance
• growth
• a positive and fun culture

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level